Interactive Text Messaging to Promote Responsive Bottle-Feeding Among Mothers of Infants Enrolled in the Special...

Responsive feeding supports healthy growth and may reduce obesity risk, yet bottle-feeding can promote nonresponsive feeding practices such as pressuring infants to finish their bottle. Because the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) serves many U.S. infants and bottle-feeding is common, scalable strategies are needed. We tested feasibility, acceptability, and preliminary effectiveness of GrowWell, an automated text-messaging program to support responsive bottle-feeding.

We conducted a 12-week randomized attention-control trial among mothers of bottle-fed infants ≤7 weeks old enrolled in WIC (n = 60; intervention n = 31; control n = 29). Participants received weekly goals, twice-weekly self-monitoring prompts with tailored feedback, and daily skills training; controls received texts focused on infant safety. Feasibility was assessed by response to self-monitoring prompts; acceptability by postintervention satisfaction surveys; and preliminary effectiveness by change in Infant Feeding Style Questionnaire (IFSQ) scores. Intervention participants completed semistructured interviews analyzed using rapid qualitative methods.

Mean response rate to self-monitoring prompts was 71.9% and did not differ by group. Satisfaction survey responses (n = 56, 30 intervention, 26 control) indicated high acceptability (≥80% agreement across items), with consistently higher ratings in the intervention group. Overall changes in IFSQ scores did not differ between groups (n = 58, 31 intervention, 27 control); however, within-group analyses showed reductions in pressuring to finish (p = 0.012) and pressuring to soothe (p = 0.002) among intervention participants at 12 weeks. Exploratory interaction analyses suggested heterogeneity by select sociodemographic characteristics. Interviews among intervention participants (n = 16) indicated high satisfaction, increased awareness of cues, and adoption of responsive practices.

GrowWell was feasible and highly acceptable, with promising preliminary signals for reducing pressuring bottle-feeding practices.